Care for People Living With HIV/AIDS in Primary Health Care in the city of Rio de Janeiro: an implementation evaluation

Abstract

This article aimed to evaluate the implementation of a decentralized care model for People
Living With HIV/AIDS (PLWHA) in the city of Rio de Janeiro, by analyzing the context that enabled it
and the degree of its implementation at the end of the time frame studied (2013-2016). During this period,
infectologist-centered HIV/AIDS care was replaced by one centered in Primary Health Care (PHC), in the
context of strengthening the Family Health Strategy. By interviewing administrators and analyzing secondary
data, we studied the process from city health managers’ viewpoint, described its main characteristics and the
degree to which decentralization measures were implemented. As a result, we observed how national guidelines
influenced the implementation of changes in the municipal PHC structure, especially in the restructuring of
HIV care, and the tensions among key players (administrators, PHC doctors, infectologists, and PLWHA).
Among the characteristics of the new model, increasing healthcare access, enhancing integrality and coordi-
nation of care were features most commonly cited in the interviews. Finally, the degree of implementation of
the decentralization policy was found to be heterogeneous, being more advanced in the fields of prevention,
diagnosis and access to medication, and less in comprehensive care and coordination of care.